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Chapter 5 Cardiovascular System Learning Objectives Upon completion of this chapter, you will be able to: ● Recognize the combining forms, prefixes, and suffixes introduced in this chapter. ● Gain the ability to pronounce medical terms and major anatomical structures. ● List the major organs of the cardiovascular system and their functions. ● Describe the flow of blood through the heart and the body. ● Explain how the electrical conduction system controls the heartbeat. ● Build cardiovascular system medical terms from word parts. ● Define vocabulary, pathology, diagnostic, and therapeutic medical terms relating to the cardiovascular system. ● Recognize types of medication associated with the cardiovascular system. ● Interpret abbreviations associated with the cardiovascular system. MedMedia www.prenhall.com/fremgen Additional interactive resources and activities for this chapter can be found on the Companion Website. For animations, audio glossary, and review, access the accompanying CD-ROM in this book. Chapter Outline Overview Anatomy and Physiology Word Building Vocabulary Pathology Professional Profile Diagnostic Procedures Therapeutic Procedures Cardiovascular Professionals Pharmacology Cardiology technologists, electrocardiogram technicians, and cardiac sonographers are all involved in the diagnosis and treatment of heart and blood vessel disease. The results of the tests and procedures they conduct are vitally important for the diagnosis and treatment of cardiovascular disease. These health care professionals are found wherever procedures to study the functioning of the cardiovascular system are performed. This includes hospitals, physicians’ offices, cardiac rehabilitation programs, and diagnostic centers. Abbreviations Cardiology Technologist Professional Journal ● ● ● Assists with invasive heart procedures Includes cardiac catheterizations and angioplasty procedures Must complete an accredited 2-to 4-year program Electrocardiogram Technician ● ● ● Conducts tests to record the electrical activity of the heart Includes electrocardiography (EKGs), Holter monitoring, and stress testing May complete a 1-year certification program or receive on-the-job training Cardiac Sonographer ● ● Uses ultrasound to produce a moving image of the heart for diagnostic purposes Graduates from a 1-year certification, 2-year associate’s degree, or 4-year baccalaureate program For more information regarding these health careers, visit the following websites: Alliance of Cardiovascular Professionals at www.acp-online.org American Society of Echocardiography at www.asecho.org Chapter Review Pronunciation Practice Case Study Chart Note Transcription Practice Exercises Overview Organs of the Cardiovascular System blood vessels arteries capillaries veins heart Combining Forms Relating to the Cardiovascular System angi/o arteri/o aort/o ather/o atri/o cardi/o coron/o cyan/o hemangi/o ox/i vessel artery aorta fatty substance atrium heart heart blue blood vessel oxygen ox/o pericardi/o phleb/o sphygm/o steth/o thromb/o valv/o valvul/o ven/o ventricul/o oxygen pericardium vein pulse chest clot valve valve vein ventricle Prefixes Relating to the Cardiovascular System Prefix Meaning Example bradytachy- slow fast bradycardia tachycardia Suffixes Relating to the Cardiovascular System Suffix Meaning Example -manometer -ole -sclerosis -stenosis -tension -ule instrument to measure pressure small hardening narrowing pressure small sphygmomanometer arteriole arteriosclerosis mitral stenosis hypotension venule Anatomy and Physiology of the Cardiovascular System amino acids arteries blood vessels capillaries carbon dioxide 130 circulatory system deoxygenated glucose heart metabolism oxygen oxygenated pulmonary circulation systemic circulation veins The cardiovascular (CV) system is also called the circulatory system. This system, which maintains the distribution of blood throughout the body, is composed of the heart and the blood vessels—arteries, capillaries, and veins. The circulatory system is composed of two parts: the pulmonary circulation (PULL mon air ee ser kew LAY shun) and the systemic circulation (sis TEM ik ser kew LAY shun). The pulmonary circulation, between the heart and lungs, transports deoxygenated (dee OK sih jen ay ted) blood to the lungs to get oxygen, and then back to the heart. The systemic circulation carries oxygenated (OK sih jen ay ted) blood away from the heart to the tissues and cells, and then back to the heart. In this way all the body cells receive blood and oxygen (see ■ Figure 5.1). In addition to distributing oxygen and other nutrients, such as glucose (GLOO kohs) and amino acids, the cardiovascular system collects the waste products from the cells. Carbon dioxide and other waste products from metabolism (meh TAB oh lizm) are transported by the cardiovascular system to the lungs and kidneys, where they are eliminated from the body. Heart apex cardiac muscle The heart is actually a muscular pump made up of cardiac (CAR dee ak) muscle fibers that could be called a muscle rather than an organ. It has four chambers or cavities and beats an average of 60 to 100 beats per minute (bpm) or about 100,000 times in one day. Each time the cardiac muscle contracts, blood is ejected from the heart and pushed throughout the body within the blood vessels. The heart is located in the mediastinum in the center of the chest cavity. However, it is not exactly centered; more of the heart is on the left side of the mediastinum than the right. It is about the size of a fist and is shaped like an upside-down pear (see ■ Figure 5.2). The tip of the heart at the lower edge is called the apex (AY peks). The sternum is located directly in front of the heart. MED TERM TIP Locating the tip of the sternum, called the xiphoid process, is important when administering cardiopulmonary resuscitation (CPR). Chest compressions must be made over the center of the sternum and not over the xiphoid process. Heart Layers endocardium epicardium myocardium parietal pericardium pericardium visceral pericardium The wall of the heart is quite thick and composed of three layers (see ■ Figure 5.3): 1. The endocardium (en doh CAR dee um) is the inner layer of the heart that lines the heart chambers. It is a very smooth, thin layer that serves to reduce friction as the blood passes through the heart chambers. 2. The myocardium (my oh CAR dee um) is the thick muscular middle layer of the heart. Contraction of this muscle layer develops the pressure required to pump blood through the blood vessels. 3. The epicardium (ep ih CAR dee um) is the outer layer of the heart. The heart is enclosed within the double-layered pleural sac, the pericardium (pair ih CAR dee um). The epicardium is the visceral pericardium (VISS er al pair ih CAR dee um), or inner layer of the sac. The outer layer of the sac is the parietal pericardium (pah RYE eh tal pair ih CAR dee um). Fluid between the two layers of the sac reduces friction as the heart beats. Cardiovascular System 131 MAJOR VEINS MAJOR ARTERIES Carotid • • Pulmonary Artery Pulmonary Vein Superior Vena Cava • • • Aorta Brachial Radial • • Inferior Vena Cava • • Femoral • Posterior Tibial • • Dorsal Pedis ■ FIGURE 5.1 132 The circulatory system. Chapter 5 Midsternal line Mediastinum (the organs between the pleural cavities) 2nd rib Sternum Diaphragm Superior vena cava Left lung Aorta (a) Posterior Pulmonary trunk Pericardium (cut) Apex of heart Diaphragm (b) ■ FIGURE 5.2 Location of the heart in the chest cavity. Superior vena cava Left atrium Right atrium Left ventricle Endocardium Myocardium Pericardium Right ventricle Inferior vena cava ■ FIGURE 5.3 The heart: interior view of the heart chambers. Cardiovascular System 133 MED TERM TIP These layers become important when studying the disease conditions affecting the heart. For instance, when the prefix endo- is added to carditis, forming endocarditis (en doh car DYE tis), we know that the inflammation is within the inner layer of the heart. In discussing the muscular action of the heart the prefix myo-, meaning muscle, is added to cardium to form the word myocardium. The diagnosis myocardial infarction (MI), or heart attack, means that the patient has an infarct or dead tissue in the muscle of the heart. The prefix peri-, meaning around, when added to the word cardium, refers to the sac surrounding the heart. Therefore, pericarditis (pair ih car DYE tis) is an inflammation of the outer sac of the heart. Heart Chambers atria interatrial septum interventricular septum ventricles The heart is divided into four chambers or cavities (see Figure 5.3). There are two atria (AY tree ah), or upper chambers, and two ventricles (VEN trik lz), or lower chambers. These are divided into right and left sides by walls called the interatrial septum (in ter AY tree al SEP tum) and the interventricular septum (in ter ven TRIK yoo lar SEP tum). The atria are the receiving chambers of the heart. Blood returning to the heart via veins first collects in the atria. The ventricles are the pumping chambers. They have a much thicker myocardium and its contraction ejects blood out of the heart and into the great arteries. Heart Valves aortic valve atrioventricular valve bicuspid valve cusps mitral valve pulmonary valve semilunar valve tricuspid valve Four valves act as restraining gates to control the direction of blood flow. They are situated at the entrances and exits to the ventricles (see ■ Figures 5.4 and 5.5). Properly functioning valves allow blood to flow only in the forward direction by blocking it from returning to the previous chamber. The valves are as follows: 1. Tricuspid (try CUSS pid) valve: This is an atrioventricular (ay tree oh ven TRIK yoo lar) valve (AV), meaning that it controls the opening between the right atrium and the right ventricle. Once the blood enters the right ventricle it cannot back up into the atrium again. The prefix tri-, meaning three, indicates that this valve has three leaflets or cusps. 2. Pulmonary (PULL mon air ee) valve: This is a semilunar (sem ih LOO nar) valve. The prefix semi-, meaning half, and the term lunar, meaning moon, indicate that this valve looks like a half moon. Located between the right ventricle and the pulmonary artery, this important valve allows blood to flow from the right ventricle into the pulmonary artery. 3. Mitral (MY tral) valve: This is also called the bicuspid (bye CUSS pid) valve, indicating that it has two cusps. Blood flows through this atrioventricular valve to the left ventricle and cannot back up into the left atrium. 4. Aortic (ay OR tik) valve: Blood leaves the left ventricle through this semilunar valve between the left ventricle and into the aorta. 134 Chapter 5 Pulmonary valve Aortic valve Area of cutaway Mitral valve Tricuspid valve Myocardium Tricuspid (right atrioventricular) valve Mitral (left atrioventricular) valve Aortic semilunar valve Pulmonary semilunar valve Anterior ■ FIGURE 5.4 The valves of the heart. ■ FIGURE 5.5 Heart valves. (Charles Stewart and Associates) MED TERM TIP The heart makes two distinct sounds referred to as “lub-dupp.” These sounds are produced by the forceful snapping shut of the heart valves. Lub is the closing of the atrioventricular valves. Dupp is the closing of the semilunar valves. Listening to these sounds with a stethoscope is part of determining if the valves are functioning properly. Cardiovascular System 135 Blood Flow Through the Heart aorta diastole inferior vena cava pulmonary artery pulmonary veins superior vena cava systole The flow of blood through the heart is quite orderly (see ■ Figure 5.6). It progresses through the heart to the lungs, where it receives oxygen; back to the heart; and then out to the body tissues and parts. The normal blood flow is as follows: 1. Deoxygenated blood from all the tissues in the body, except lung tissue, enters a relaxed right atrium via two large veins called the superior vena cava (soo PEE ree or VEE nah KAY ) and inferior vena cava. (in FEE ree or VEE nah KAY vah). 2. The right atrium contracts and blood flows through the tricuspid valve into the relaxed right ventricle. 3. The right ventricle then contracts and blood is pumped through the pulmonary valve into the pulmonary (PULL mon air ee) artery, which carries it to the lungs. From body Superior vena cava Aorta To lung Right pulmonary artery (branches) To lung Left pulmonary artery (branches) From lung Right pulmonary vein (branches) 4 From lung Left pulmonary vein (branches) 1 Right atrium 6 5 Left atrium Bicuspid valve 3 2 Tricuspid valve Left ventricle Epicardium (outer layer) Interventricular septum Right ventricle Myocardium (heart muscle) Inferior vena cava Apex Descending aorta From body To body ■ FIGURE 5.6 136 Chapter 5 Blood flow through the heart. 4. The left atrium receives blood that has been oxygenated by the lungs. This blood enters the relaxed left atrium from the four pulmonary (PULL mon air ee) veins. 5. The left atrium contracts and blood flows through the mitral valve into the relaxed left ventricle. 6. When the left ventricle contracts, the blood is pumped through the aortic valve and into the aorta (ay OR tah), the largest artery in the body. The aorta carries blood to all parts of the body except the lungs. It can be seen that the heart chambers alternate between relaxing in order to fill and contracting to push blood forward. The period of time a chamber is relaxed is diastole (dye ASS toe lee). The contraction phase is systole (SIS toe lee). Conduction System of the Heart atrioventricular node autonomic nervous system bundle branches bundle of His pacemaker Purkinje fibers sinoatrial node The autonomic nervous system (aw toh NOM ik NER vus SIS tem) regulates heart rate; therefore we have no voluntary control over the beating of our heart. Special tissue within the heart is responsible for conducting an electrical impulse that stimulates the different chambers to contract in the correct order. The path that the impulses travel is as follows (see ■ Figure 5.7): 1. The sinoatrial (sigh noh AY tree al) (SA) node, or pacemaker, is where the electrical impulse begins. From the sinoatrial node a wave of electricity travels through the atria, causing them to contract, or go into systole. 2. Next, the atrioventricular (ay tree oh ven TRIK yoo lar) node is stimulated. Right atrium Superior vena cava 1 Sinoatrial node (pacemaker) Internodal pathway 2 Atrioventricular node 3 Atrioventricular bundle (Bundle of His) Left atrium Purkinje fibers 4 Bundle branches 5 Purkinje fibers ■ FIGURE 5.7 Interventricular septum Conduction system of the heart. Cardiovascular System 137 S-A node P wave QRS complex T wave corresponds to contraction of the atria correlates to ventricles contracting represents preparation for next series of complexes ■ FIGURE 5.8 EKG tracing. 3. This node transfers the stimulation wave to the bundle of His. 4. The electrical signal next travels down the bundle branches within the interventricular septum. 5. Finally, the Purkinje (per KIN gee) fibers out in the ventricular myocardium are stimulated, which results in ventricular systole. MED TERM TIP The electrocardiogram, which is referred to as an EKG or ECG, is a measurement of the electrical activity of the heart (see ■ Figure 5.8). This can give the physician information about the health of the heart, especially the myocardium. Blood Vessels arterioles capillary bed coronary arteries venules There are three types of blood vessels: arteries, capillaries, and veins. The arteries are the large, thick-walled vessels that carry the blood away from the heart (see ■ Figure 5.9). The pulmonary artery carries deoxygenated blood, or blood without oxygen, from the right ventricle to the lungs. The largest artery, the aorta, begins from the left ventricle of the heart and carries oxygenated blood, or blood with oxygen, to all the body systems. The coronary arteries (KOR ah nair ee AR te reez) then branch from the aorta and provide blood to the myocardium (see ■ Figure 5.10). As they travel through the body the arteries branch into progressively smaller arteries. The smallest arteries are called arterioles (ar TEE ree ohlz). Arterioles deliver blood to the capillaries. Capillaries are a network of tiny blood vessels referred to as a capillary bed. Arterial blood flows into a capillary bed and venous blood flows back out. Capillaries are very thin walled, allowing for the diffusion of the oxygen from the 138 Chapter 5 Right common carotid artery Left common carotid artery Left subclavian artery Right subclavian artery Aortic arch Ascending aorta Descending aorta Celiac trunk Brachial artery Common iliac artery Radial artery Renal artery Internal Iliac artery Ulnar artery Deep palmer arch External iliac artery Superficial palmar arch Deep femoral artery Femoral artery Popliteal artery Posterior tibial artery Peroneal artery Anterior tibial artery Dorsalis pedis Plantar arch ■ FIGURE 5.9 Major arteries of the systemic circulation. Cardiovascular System 139 Base (superior) Right coronary artery Left coronary artery Apex (inferior) Anterior descending branch ■ FIGURE 5.10 Coronary arteries. blood and into the body tissues. Likewise, waste products are able to diffuse out of the body tissues and into the bloodstream to be carried away. Since the capillaries are so small in diameter, the blood will not flow as quickly through them as it does through the arteries and veins. This means that the blood has time for an exchange of nutrients, oxygen, and waste material to take place. As blood exits a capillary bed, it returns to the heart in a vein. The veins carry blood back to the heart (see ■ Figure 5.11). Blood leaving capillaries first enters small venules (VEN yools), which then merge into larger veins. Veins have much thinner walls than arteries, causing them to collapse easily. The veins also have valves that allow the blood to move only toward the heart. These valves prevent blood from backing away from the heart. The two large veins that enter the heart are the superior vena cava, which carries blood from the upper body, and the inferior vena cava, which carries blood from the lower body. Blood pressure in the veins is much lower than it is in the arteries. Muscular action against the veins and skeletal muscle contractions help in the movement of blood. See ■ Figure 5.12 for an illustration of blood circulation through the cardiovascular system. Blood Pressure blood pressure (BP) diastolic pressure sphygmomanometer systolic pressure Blood pressure (BP) is a measurement of the force exerted by blood against the wall of a blood vessel. During ventricular systole, blood is under a lot of pressure from the ventricular contraction, giving the highest blood pressure reading—the systolic (sis TOL ik) pressure. During ventricular diastole, blood is not being pushed by the heart at all and the blood pressure reading drops to its lowest point—the diastolic (dye ah STOL ik) pressure. Therefore, to see the full range of what is occurring with blood pressure, both numbers are required. Blood pressure is also affected by several other characteristics of the blood and the blood vessels. These include the elasticity of the arteries, the diameter of the blood vessels, the viscosity of the blood, the volume of blood flowing through the vessels, and the amount of resistance there is to blood flow. 140 Chapter 5 External jugular vein Internal jugular vein Vertebral vein Superior vena cava Great cardiac vein Subclavian vein Right and left brachiocephalic veins Cephalic vein Brachial vein Hepatic portal vein Superior mesenteric vein Inferior vena cava Ulnar vein Radial vein Basilic vein Splenic vein Median cubital vein Renal vein Inferior mesenteric vein Common iliac vein External iliac vein Internal iliac vein Digital veins Femoral vein Great saphenous vein Popliteal vein Posterior tibial vein Anterior tibial vein Fibular vein ■ FIGURE 5.11 Major veins of the systemic circulation. Cardiovascular System 141 Capillary beds of lungs where gas exchange occurs Pulmonary veins Pulmonary Circuit Pulmonary arteries Aorta and branches Venae cavae Left atrium Left ventricle Right atrium Right ventricle Systemic Circuit Key: = Oxygen rich, CO2-poor blood Capillary beds of all body tissues where gas exchange occurs = Oxygen poor, CO2-rich blood ■ FIGURE 5.12 MED TERM TIP Systemic and pulmonary circulation. The instrument used to measure blood pressure is called a sphygmomanometer (sfig moh mah NOM eh ter). The combining form sphygm/o means pulse and the suffix -manometer means instrument to measure pressure. A blood pressure reading is reported as two numbers, for example, 120/80. The 120 is the systolic pressure and the 80 is the diastolic pressure (see Figure 5.13). There is not one “normal” blood pressure number. The normal range for blood pressure in an adult is 90/60 to 140/90. 142 Chapter 5 ■ FIGURE 5.13 Taking blood pressure in an emergency setting. Word Building Relating to the Cardiovascular System The following list contains examples of medical terms built directly from word parts. The definition for these terms can be determined by a straightforward translation of the word parts. Combining Form Combined With Medical Term Definition angi/o -graphy angiography (an jee OG rah fee) making a record of a vessel -rrhaphy angiorrhaphy (an jee OR rah fee) suturing a vessel -spasm angiospasm (AN jee oh spazm) involuntary muscle contraction of a vessel -stenosis angiostenosis (an jee oh sten OH sis) narrowing of a vessel -gram aortogram (ay OR toh gram) record of the aorta -ic aortic (ay OR tik) pertaining to the aorta -al arterial (ar TEE ree al) pertaining to the artery -ole arteriole (ar TEE ree ohl) small artery -rrhexis arteriorrhexis (ar tee ree oh REK sis) ruptured artery -sclerosis arteriosclerosis (ar tee ree oh skleh ROH sis) hardening of an artery -ectomy atherectomy (ath er EK toh mee) excision of fatty substance -sclerosis atherosclerosis (ath er oh skleh ROH sis) hardening with fatty substance -al atrial (AY tree al) pertaining to the atrium inter- -al interatrial (in ter AY tree al) pertaining to between the atria aort/o arteri/o ather/o atri/o continued... Cardiovascular System 143 Word Building Relating to the Cardiovascular System (continued) Combining Form Combined With Medical Term Definition cardi/o -ac cardiac (CAR dee ak) pertaining to the heart brady- -ia bradycardia (brad ee CAR dee ah) state of slow heart -dynia cardiodynia (car dee oh DIN ee ah) heart pain electr/o -gram electrocardiogram (ee lek tro CAR dee oh gram) record of heart electricity -megaly cardiomegaly (car dee oh MEG ah lee) enlarged heart my/o -al myocardial (my oh CAR dee al) pertaining to heart muscle my/o -pathy cardiomyopathy (car dee oh my OP ah thee) heart muscle disease -ologist cardiologist (car dee ALL oh jist) specialist in the cardiovascular system -rrhaphy cardiorrhaphy (car dee OR ah fee) suture the heart tachy- -ia tachycardia (tak ee CAR dee ah) state of fast heart coron/o -ary coronary (KOR ah nair ee) pertaining to the heart phleb/o -itis phlebitis (fleh BYE tis) inflammation of a vein -otomy phlebotomy (fleh BOT oh me) incision in a vein -rrhaphy phleborrhaphy (fleh BOR ah fee) suture a vein -itis valvulitis (val view LYE tis) inflammation of a valve -ar valvular (VAL view lar) pertaining to a valve -ous venous (VEE nus) pertaining to a vein -ule venule (VEN yool) small vein -otomy venotomy (vee NOT oh mee) incision into a vein -ar ventricular (ven TRIK yoo lar) pertaining to a ventricle inter- -ar interventricular (in ter ven TRIK yoo lar) pertaining to between the ventricles valvul/o ven/o ventricul/o Vocabulary Relating to the Cardiovascular System auscultation (oss kul TAY shun) Process of listening to the sounds within the body by using a stethoscope (see ■ Figure 5.14). bruit (brew EE) Term used interchangeably with the word murmur. A gentle, blowing sound that is heard during auscultation. cardiology (car dee ALL oh jee) The branch of medicine relating to the cardiovascular system. cyanosis (sigh ah NOH sis) Slightly bluish color of the skin due to a deficiency of oxygen and an excess of carbon dioxide in the blood. It is caused by a variety of disorders, ranging from chronic lung disease to congenital and chronic heart problems. infarct (IN farkt) Area of tissue within an organ or part that undergoes necrosis (death) following the loss of its blood supply. 144 Chapter 5 Vcabulary Relating to the Cardiovascular System (continued) ischemia (is KEYH mee ah) Localized and temporary deficiency of blood supply due to an obstruction to the circulation. lumen (LOO men) The space, cavity, or channel within a tube or tubular organ or structure in the body. murmur (MUR mur) An abnormal heart sound such as a soft blowing sound or harsh click. It may be soft and heard only with a stethoscope, or so loud it can be heard several feet away. Also referred to as a bruit. palpitations (pal pih TAY shunz) Pounding, racing heart beat. pulse Expansion and contraction of a blood vessel wall produced by blood as it moves through an artery. The pulse can be taken at several pulse points throughout the body where an artery is close to the surface. sphygmomanometer (sfig moh mah NOM eh ter) Instrument for measuring blood pressure. Also referred to as a blood pressure cuff. stent A stainless steel tube placed within a blood vessel or a duct to widen the lumen (see ■ Figure 5.15). stethoscope (STETH oh scope) Instrument for listening to body sounds (auscultation), such as the chest, heart, or intestines. ■ FIGURE 5.14 A B Auscultation. C ■ FIGURE 5.15 Placement of a stent. (A) The stainless steel stent is fitted over a balloon-tipped catheter. (B) The stent is positioned along the blockage and expanded. (C) The balloon is deflated and removed, leaving the stent in place. Cardiovascular System 145 Pathology of the Cardiovascular System aneurysm (AN yoo rizm) Weakness in the wall of an artery that results in localized widening of the artery. Although an aneurysm may develop in any artery, common sites include the aorta in the abdomen and the cerebral arteries in the brain (see ■ Figure 5.16). angina pectoris (an JYE nah PECK tor is) Condition in which there is severe pain with a sensation of constriction around the heart. Caused by a deficiency of oxygen to the heart muscle. angiocarditis (an je oh kar DYE tis) Inflammation of blood vessels and the heart. angioma (an jee OH ma) Tumor, usually benign, consisting of a network of blood vessels. angiospasm (AN jee oh spazm) Spasm or contraction of smooth muscle in the walls of a blood vessel. aortic stenosis (ay OR tik steh NOH sis) Narrowing of the aorta. arrhythmia (ah RITH mee ah) Irregularity in the heartbeat or action. Comes in many different forms; some are not serious, while others are life threatening. arteriosclerosis (ar tee ree oh skleh ROH sis) Thickening, hardening, and loss of elasticity of the walls of the arteries. Most often due to atherosclerosis. arteriosclerotic (ar tee ree oh skleh ROT ik) heart disease (ASHD) Chronic heart disorder caused by a hardening of the walls of the coronary arteries. May lead to coronary artery disease, angina pectoris, and myocardial infarction. atherosclerosis (ath er oh skleh ROH sis) The most common form of arteriosclerosis. Caused by the formation of yellowish plaques of cholesterol on the inner walls of arteries. cardiac arrest Complete stopping of heart activity. cardiomyopathy (car dee oh my OP ah thee) General term for a disease of the myocardium. Can be caused by alcohol abuse, parasites, viral infection, and congestive heart failure. One of the most common reasons a patient may require a heart transplant. coarctation (koh ark TAY shun) of the aorta Severe congenital narrowing of the aorta. congenital septal defect (CSD) A hole, present at birth, in the septum between two heart chambers; results in a mixture of oxygenated and deoxygenated blood. There can be an atrial septal defect (ASD) and a ventricular septal defect (VSD). congestive (kon JESS tiv) heart failure (CHF) Pathological condition of the heart in which there is a reduced outflow of blood from the left side of the heart because the left ventricle myocardium has become too weak to efficiently pump blood. Results in weakness, breathlessness, and edema. coronary artery disease (KOR ah nair ee AR ter ee dis EEZ) (CAD) Insufficient blood supply to the heart muscle due to an obstruction of one or more coronary arteries. May be caused by atherosclerosis and may cause angina pectoris and myocardial infarction (see ■ Figure 5.17). embolus (EM boh lus) The obstruction of a blood vessel by a blood clot that has broken off from a thrombus somewhere else in the body and traveled to the point of obstruction. If it occurs in a coronary artery, it may result in a myocardial infarction (see ■ Figure 5.18). endocarditis (en doh car DYE tis) Inflammation of the lining membranes of the heart. May be due to bacteria or to an abnormal immunological response. In bacterial endocarditis, the mass of bacteria that forms is referred to as vegetation. fibrillation (fih brill AY shun) An extremely serious arrhythmia characterized by an abnormal quivering or contractions of heart fibers. When this occurs in the ventricles, cardiac arrest and death can occur. Emergency equipment to defibrillate, or convert the heart to a normal beat, is necessary. flutter An arrhythmia in which the atria beat too rapidly, but in a regular pattern. 146 Chapter 5 Pathology of the Cardiovascular System (continued) heart block Occurs when the electrical impulse is blocked from traveling down the bundle of His or bundle branches. Results in the ventricles beating at a different rate than the atria. Also called a bundle branch block (BBB). heart valve prolapse (PROH laps) The cusps or flaps of the heart valve are too loose and fail to shut tightly, allowing blood to flow backward through the valve when the heart chamber contracts. Most commonly occurs in the mitral valve, but may affect any of the heart valves. heart valve stenosis (steh NOH sis) The cusps or flaps of the heart valve are too stiff. Therefore, they are unable to open fully, making it difficult for blood to flow through, or shut tightly, allowing blood to flow backward. This condition may affect any of the heart valves. hemangioma (he man gee OH ma) A benign mass of blood vessels. Often causing a visible dark red lesion present from birth. Also called a birthmark. hemorrhoid (HIM oh royd) Varicose veins in the anal region. hypertension (high per TEN shun) (HTN) Blood pressure above the normal range. hypertensive (high per TEN siv) heart disease Heart disease as a result of persistently high blood pressure, which damages the blood vessels and ultimately the heart. hypotension (high poh TEN shun) Decrease in blood pressure. Can occur in shock, infection, cancer, anemia, or as death approaches. myocardial infarction (my oh CAR dee al in FARC shun) (MI) Condition caused by the partial or complete occlusion or closing of one or more of the coronary arteries (see ■ Figure 5.19). Symptoms include a squeezing pain or heavy pressure in the middle of the chest (angina pectoris). A delay in treatment could result in death. Also referred to as a heart attack. myocarditis (my oh car DYE tis) Inflammation of the muscle layer of the heart wall. patent ductus arteriosus (PAY tent DUCK tus ar tee ree OH sis) (PDA) Congenital heart anomaly in which the fetal connection between the pulmonary artery and the aorta fails to close at birth. This condition requires surgery. pericarditis (pair ih car DYE tis) Inflammation of the pericardial sac around the heart. peripheral vascular disease (PVD) Any abnormal condition affecting blood vessels outside the heart. Symptoms may include pain, pallor, numbness, and loss of circulation and pulses. polyarteritis (pol ee ar ter EYE tis) Inflammation of several arteries. Raynaud’s phenomenon (ray NOZ) Periodic ischemic attacks affecting the extremities of the body, especially the fingers, toes, ears, and nose. The affected extremities become cyanotic and very painful. These attacks are brought on by arterial constriction due to extreme cold or emotional stress. Named after a French physician, Maurice Raynaud. rheumatic (roo MAT ik) heart disease Valvular heart disease as a result of having had rheumatic fever. tetralogy of Fallot (teh TRALL oh jee of fal LOH) Combination of four congenital anomalies: pulmonary stenosis, an interventricular septal defect, improper placement of the aorta, and hypertrophy of the right ventricle. Needs immediate surgery to correct. Named for Etienne-Louis Fallot, a French physician. thrombophlebitis (throm boh fleh BYE tis) Inflammation of a vein that results in the formation of blood clots within the vein. thrombus (THROM bus) A blood clot forming within a blood vessel (see ■ Figure 5.20). May partially or completely occlude the blood vessel. varicose (VAIR ih kohs) veins Swollen and distended veins, usually in the legs. Cardiovascular System 147 Aorta Right kidney Aneurysm Inferior vena cava ■ FIGURE 5.16 Abdominal aortic aneurysm. ■ FIGURE 5.17 atherosclerosis. Coronary artery disease due to Internal carotid External carotid Embolus Common carotid artery Area of infarct • ■ FIGURE 5.18 148 Chapter 5 Embolus. ■ FIGURE 5.19 Cross section of myocardial infarction. Platelets and fibrin deposit on plaque and initiate clot formation A Smooth muscle Plaque Moderate narrowing of lumen Thrombus partially occluding lumen Thrombus completely occluding lumen B ■ FIGURE 5.20 Thrombus formation in an atherosclerotic vessel. Depicted are (A) the initial clot formation and (B) the varying degrees of occlusion. Diagnostic Procedures Relating to the Cardiovascular System angiography (an jee OG rah fee) X-rays taken after the injection of an opaque material into a blood vessel. Can be performed on the aorta as an aortic angiogram, on the heart as an angiocardiogram, and on the brain as a cerebral angiogram. cardiac catheterization (CAR dee ak cath eh ter ih ZAY shun) Passage of a thin tube (catheter) through a blood vessel leading to the heart. Done to detect abnormalities, to collect cardiac blood samples, and to determine the blood pressure within the heart. cardiac enzymes (CAR dee ak EN zyms) Blood test to determine the level of enzymes specific to heart muscles in the blood. An increase in the enzymes may indicate heart muscle damage such as a myocardial infarction. These enzymes include creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and glutamic oxaloacetic transaminase (GOT). cardiac scan Patient is given radioactive thallium intravenously and then scanning equipment is used to visualize the heart. It is especially useful in determining myocardial damage. coronary angiography (an jee OG rah fee) Radiographic X-ray of the heart and large vessels after the injection of a radiopaque solution. X-rays are taken in rapid sequence as the material moves through the heart. Doppler ultrasonography Measurement of sound-wave echoes as they bounce off tissues and organs to (DOP ler ul trah son OG rah fee) produce an image. Can assist in determining heart and blood vessel damage. Named for Christian Doppler, an Austrian physicist. echocardiography (ek oh car dee OG rah fee) Noninvasive diagnostic method using ultrasound to visualize internal cardiac structures. Cardiac valve activity can be evaluated using this method. electrocardiography (ee lek troh car dee OG rah fee) (ECG, EKG) Record of the electrical activity of the heart. Useful in the diagnosis of abnormal cardiac rhythm and heart muscle (myocardium) damage. continued... Cardiovascular System 149 Diagnostic Procedures Relating to the Cardiovascular System (continued) Holter monitor Portable ECG monitor worn by a patient for a period of a few hours to a few days to assess the heart and pulse activity as the person goes through the activities of daily living. Used to assess a patient who experiences chest pain and unusual heart activity during exercise and normal activities. Named for Norman Holter, an American biophysicist. serum lipoprotein (SEE rum lip oh PROH teen) level Blood test to measure the amount of cholesterol and triglycerides in the blood. An indicator of atherosclerosis risk. stress testing Method for evaluating cardiovascular fitness. The patient is placed on a treadmill or a bicycle and then subjected to steadily increasing levels of work. An EKG and oxygen levels are taken while the patient exercises. The test is stopped if abnormalities occur on the EKG. Also called an exercise test or a treadmill test. venography (vee NOG rah fee) X-ray of the veins by tracing the venous pulse. Also called phlebography. Therapeutic Procedures Relating to the Cardiovascular System aneurysmectomy (an yoo riz MEK toh mee) Surgical removal of the sac of an aneurysm. angioplasty (AN jee oh plas tee) Surgical procedure of altering the structure of a vessel by dilating it using a balloon inside the vessel (see ■ Figure 5.21). arterial anastomosis (ar tee REE all ah nas toe MOE sis) Surgical joining together of two arteries. Performed if an artery is severed or if a damaged section of an artery is removed. cardiopulmonary resuscitation (car dee oh PULL mon air ee ree suss ih TAY shun) (CPR) Procedure to restore cardiac output and oxygenated air to the lungs for a person in cardiac arrest. A combination of chest compressions (to push blood out of the heart) and artificial respiration (to blow air into the lungs) performed by one or two CPR-trained rescuers. commissurotomy (com ih shur OT oh mee) Surgical incision to change the size of an opening. For example, in mitral commissurotomy, a stenosis or narrowing is treated by cutting away at the adhesions around the mitral opening (orifice). coronary (KOR ah nair ee) artery bypass graft (CABG) Open-heart surgery in which a blood vessel from another location in the body (often a leg vein) is grafted to route blood around a blocked coronary artery. defibrillation (dee fib rih LAY shun) A procedure that converts serious irregular heartbeats, such as fibrillation, by giving electric shocks to the heart using an instrument called a defibrillator. Also called cardioversion (see ■ Figure 5.22). embolectomy (em boh LEK toh mee) Removal of an embolus or clot from a blood vessel. endarterectomy (end ar teh REK toh mee) Excision of the diseased or damaged inner lining of an artery. Usually performed to remove atherosclerotic plaques. extracorporeal (EX tra core poor EE al) circulation (ECC) During open-heart surgery, the routing of blood to a heart-lung machine so it can be oxygenated and pumped to the rest of the body. heart transplantation Replacement of a diseased or malfunctioning heart with a donor’s heart. 150 Chapter 5 Therapeutic Procedures Relating to the Cardiovascular System (continued) intracoronary artery (in trah KOR ah nair ee AR ter ee) stent Placing a stent within a coronary artery to treat coronary ischemia due to atherosclerosis. ligation (lye GAY shun) and stripping Surgical treatment for varicose veins. The damaged vein is tied off (ligation) and removed (stripping). open-heart surgery Surgery that involves incision of the heart, coronary arteries, or heart valves. pacemaker implantation Electrical device that substitutes for the natural pacemaker of the heart (see ■ Figure 5.23A). It controls the beating of the heart by a series of rhythmic electrical impulses. An external pacemaker has the electrodes on the outside of the body. An internal pacemaker has the electrodes surgically implanted within the chest wall (see ■ Figure 5.23B). percutaneous transluminal coronary angioplasty (per kyoo TAY nee us trans LOO mih nal KOR ah nair ee AN jee oh plas tee) (PTCA) Method for treating localized coronary artery narrowing. A balloon catheter is in serted through the skin into the coronary artery and inflated to dilate the narrow blood vessel. pericardiocentesis (pair ih CAR dee oh sin tee sis) Insertion of a needle into the pericardial sac for the purpose of aspirating excess fluid around the heart. phlebotomy (fleh BOT oh mee) Creating an opening into a vein (inserting a needle) to withdraw blood. thrombectomy (throm BEK toh mee) Surgical removal of a thrombus or blood clot from a blood vessel. thrombolytic therapy (throm boh LIT ik THAIR ah pee) Drugs, such as streptokinase (SK) or tissue-type plasminogen activator (tPA), are injected into a blood vessel to dissolve clots and restore blood flow. valve replacement Excision of a diseased heart valve and replacement with an artificial valve. venipuncture (VEEN ih punk cher) Puncture into a vein to withdraw fluids or insert medication and fluids. A 1. 2. 3. 4. ■ FIGURE 5.21 (A) Balloon angioplasty: 1. The balloon catheter is threaded into the affected coronary artery. 2. The balloon is positioned across the area of obstruction. 3. The balloon is then inflated, flattening the plaque against the arterial wall. (Southern Illinois University/Photo Researchers, Inc.) Cardiovascular System 151 B ■ FIGURE 5.21—continued (B) Balloon catheter. ■ FIGURE 5.22 Defibrillator (cardioverter). ■ FIGURE 5.23 (A)Heart pacemaker. (Phototake NYC/Yoav Levy) (B) Pacemaker implanted into a patient’s chest. (Photo Researcher Inc./Science Photo Library) Pharmacology Relating to the Cardiovascular System antiarrhythmic (an tye a RHYTH mik) Reduces or prevents cardiac arrhythmias. anticoagulant (an tye koh AG you lant) Prevent blood clot formation. antihypertensive (an tye hye per TEN sive) Lowers blood pressure. antilipidemic (an tye lip ih DEM ik) Reduces amount of cholesterol and lipids in the bloodstream. Treats hyperlipidemia. cardiotonic (card ee oh TAHN ik) Increases the force of cardiac muscle contraction. Treats congestive heart failure. diuretic (dye you RET ik) Increases urine production by the kidneys, which works to reduce plasma and therefore blood volume. This results in lower blood pressure. thrombolytic (throm boh LIT ik) Dissolves existing blood clots. vasoconstrictor (vaz oh kon STRICK tor) Contracts smooth muscle in walls of blood vessels. Raises blood pressure. vasodilator (vaz oh DYE late or) Relaxes the smooth muscle in the walls of arteries, thereby increasing diameter of the blood vessel. Used for two main purposes: increasing circulation to an ischemic area and reducing blood pressure. 152 Chapter 5 Abbreviations Relating to the Cardiovascular System AF atrial fibrillation ICU intensive care unit AMI acute myocardial infarction IV intravenous AS aortic stenosis, arteriosclerosis JVP jugular venous pulse ASCVD arteriosclerotic cardiovascular disease LDH lactate dehydrogenase ASD atrial septal defect LDL low-density lipoproteins ASHD arteriosclerotic heart disease LVAD left ventricular assist device AV, A-V atrioventricular LVH left ventricular hypertrophy BBB bundle branch block (L for left; R for right) MI myocardial infarction, mitral insufficiency BP blood pressure mm Hg millimeters of mercury bpm beats per minute MR mitral regurgitation CABG coronary artery bypass graft MS mitral stenosis CAD coronary artery disease MVP mitral valve prolapse cath catheterization NSR normal sinus rhythm CC cardiac catheterization, chief complaint P pulse CCU coronary care unit PAC premature atrial contraction CHF congestive heart failure PDA patent ductus arteriosus CoA coarctation of the aorta PTCA CP chest pain percutaneous transluminal coronary angioplasty CPK creatine phosphokinase PVC premature ventricular contraction CPR cardiopulmonary resuscitation S1 first heart sound CSD congenital septal defect S2 second heart sound CV cardiovascular SA, S-A sinoatrial DVT deep vein thrombosis SGOT serum glutamic oxaloacetic transaminase ECC extracorporeal circulation SK streptokinase ECG, EKG electrocardiogram tPA tissue-type plasminogen activator Vfib ventricular fibrillation ECHO echocardiogram VLDL very low density lipoproteins GOT glutamic oxaloacetic transaminase VSD ventricular septal defect HDL high-density lipoproteins VT ventricular tachycardia HTN hypertension Cardiovascular System 153 Chapter Review Pronunciation Practice You will find the pronunciation for each term on the enclosed CD-ROM. Check each one off as you master it. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 154 amino acids aneurysm (AN yoo rizm) aneurysmectomy (an yoo riz MEK toh mee) angina pectoris (an JYE nah PECK tor is) angiocarditis (an jee oh kar DYE tis) angiography (an jee OG rah fee) angioma (an jee OH mah) angioplasty (AN jee oh plas tee) angiorrhaphy (an jee OR rah fee) angiospasm (AN jee oh spazm) angiostenosis (an jee oh sten OH sis) antiarrhythmic (an tye a RHYTH mik) anticoagulant (an tye koh AG you lant) antihypertensive (an tye hye per TEN sive) antilipidemic (an tye lip ih DEM ik) aorta (ay OR tah) aortic (ay OR tik) aortic stenosis (ay OR tik steh NOH sis) aortic (ay OR tik) valve aortogram (ay OR toh gram) apex (AY peks) arrhythmia (ah RITH mee ah) arterial (ar TEE ree al) arterial anastomosis (ar TEE ree all ah nas toe MOE sis) arteries (AR teh reez) arteriole (ar TEE ree ohl) arteriorrhexis (ar tee ree oh REK sis) arteriosclerosis (ar tee ree oh skleh ROH sis) arteriosclerotic (ar tee ree oh skleh ROT ik) heart disease atherectomy (ath er EK toh mee) atherosclerosis (ath er oh skleh ROH sis) atria (AY tree ah) atrial (AY tree al) atrioventricular (ay tree oh ven TRIK yoo lar) node Chapter 5 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ atrioventricular (ay tree oh ven TRIK yoo lar) valve auscultation (oss kul TAY shun) autonomic nervous system (aw toh NOM ik NER vus SIS tem) bicuspid (bye CUSS pid) valve blood pressure blood vessels bradycardia (brad ee CAR dee ah) bruit (brew EE) bundle branches bundle of His (HISS) capillaries (CAP ih lair eez) capillary bed carbon dioxide cardiac (CAR dee ak) cardiac (CAR dee ak) arrest cardiac catheterization (CAR dee ak cath eh ter ih ZAY shun) cardiac enzymes (CAR dee ak EN zyms) cardiac (CAR dee ak) muscle cardiac (CAR dee ak) scan cardiodynia (car dee oh DIN ee ah) cardiologist (car dee ALL oh jist) cardiology (car dee ALL oh jee) cardiomegaly (car dee oh MEG ah lee) cardiomyopathy (car dee oh my OP ah thee) cardiopulmonary resuscitation (car dee oh PULL mon air ee ree suss ih TAY shun) cardiorrhaphy (car dee OR ah fee) Cardiotonic (car dee oh TAHN ik) circulatory system coarctation (koh ark TAY shun) of the aorta commissurotomy (com ih shur OT oh me) congenital septal defect congestive (kon Jess tiv) heart failure coronary (KOR ah nair ee) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ coronary angiography (KOR ah nair ee an jee OG rah fee) coronary arteries (KOR ah nair ee AR te reez) coronary artery (KOR ah nair ee AR ter ee) bypass graft coronary artery disease (KOR ah nair ee AR ter ee dis EEZ) cusps cyanosis (sigh ah NOH sis) defibrillation (dee fib rih LAY shun) deoxygenated (dee OK sih jen ay ted) diastole (dye ASS toe lee) diastolic (dye ah STOL ik) pressure diuretic (dye you RET ik) Doppler ultrasonography (DOP ler ul trah son OG rah fee) echocardiography (ek oh car dee OG rah fee) electrocardiogram (ee lek troh CAR dee oh gram) electrocardiography (ee lek troh car dee OG rah fee) embolectomy (em boh LEK toh mee) embolus (EM boh lus) endarterectomy (end ar teh REK toh mee) endocarditis (en doh car DYE tis) endocardium (en doh CAR dee um) epicardium (ep ih CAR dee um) extracorporeal (EX tra core poor EE al) circulation fibrillation (fih brill AY shun) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ flutter glucose (GLOO kohs) heart heart block heart transplantation heart valve prolapse (PROH laps) heart valve stenosis (steh NOH sis) hemangioma (he man gee OH ma) hemorrhoid (HIM oh royd) Holter monitor hypertension (high per TEN shun) hypertensive (high per TEN siv) heart disease hypotension (high poh TEN shun) infarct (IN farkt) inferior vena cava (in FEE ree or VEE nah KAY vah) interatrial (in ter AY tree al) interatrial septum (in ter AY tree al SEP tum) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ interventricular (in ter ven TRIK yoo lar) interventricular septum (in ter ven TRIK yoo lar SEP tum) intracoronary artery (in trah KOR ah nair ee AR ter ee) stent ischemia (is KEYH mee ah) ligation (lye GAY shun) and stripping lumen (LOO men) metabolism (meh TAB oh lizm) mitral (MY tral) valve murmur (MUR mur) myocardial (my oh CAR dee al) myocardial infarction (my oh CAR dee al in FARC shun) myocarditis (my oh car DYE tis) myocardium (my oh CAR dee um) open-heart surgery oxygen (OK sih jen) oxygenated (OK sih jen ay ted) pacemaker pacemaker implantation palpitations (pal pih TAY shunz) parietal pericardium (pah RYE eh tal pair ih CAR dee um) patent ductus arteriosus (PAY tent DUCK tus ar tee ree OH sis) percutaneous transluminal coronary angioplasty (per kyoo TAY nee us trans LOO mih nal KOR ah nair ree AN jee oh plas tee) pericardiocentesis (pair ih CAR dee oh sin tee sis) pericarditis (pair ih car DYE tis) pericardium (pair ih CAR dee um) peripheral vascular disease phlebitis (fleh BYE tis) phleborrhaphy (fleh BOR ah fee) phlebotomy (fleh BOT oh mee) polyarteritis (pol ee ar ter EYE tis) pulmonary (PULL mon air ee) artery pulmonary circulation (PULL mon air ee ser kew LAY shun) pulmonary (PULL mon air ee) valve pulmonary (PULL mon air ee) veins pulse Purkinje (per KIN gee) fibers Raynaud’s (ray NOZ) phenomenon Cardiovascular System 155 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ rheumatic (roo MAT ik) heart disease semilunar (sem ih LOO nar) valve serum lipoprotein (SEE rum lip oh PROH teen) level sinoatrial (sigh noh AY tree al) node sphygmomanometer (sfig moh mah NOM eh ter) stent stethoscope (STETH oh scope) stress testing superior vena cava (soo PEE ree or VEE nah KAY vah) systemic circulation (sis TEM ik ser kew LAY shun) systole (SIS toe lee) systolic (sis TOL ik) pressure tachycardia (tak ee CAR dee ah) tetralogy of Fallot (teh TRALL oh jee of fal LOH) thrombectomy (throm BEK toh mee) thrombolytic (throm boh LIT ik) thrombolytic therapy (throm boh LIT ik THAIR ah pee) thrombophlebitis (throm boh fleh BYE tis) 156 Chapter 5 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ thrombus (THROM bus) tricuspid (try CUSS pid) valve valve replacement valvular (VAL view lar) valvulitis (val view LYE tis) varicose (VAIR ih kohs) veins vasoconstrictor (vaz oh kon STRICK tor) vasodilator (vaz oh DYE late or) veins (VAYNS) venipuncture (VEEN ih punk cher) venography (vee NOG rah fee) venotomy (vee NOT oh mee) venous (VEE nus) ventricles (VEN trik lz) ventricular (ven TRIK yoo lar) venules (VEN yools) visceral pericardium (VISS er al pair ih CAR dee um) Case Study Discharge Summary Admitting Diagnosis: Difficulty breathing, hypertension, tachycardia Final Diagnosis: CHF secondary to mitral valve prolapse History of Present Illness: Patient was brought to the Emergency Room by her family because of SOB, tachycardia (a racing heart rate), and anxiety. Patient reports that she has experienced these symptoms for the past 6 months, brought on by exertion. The current episode began while she was cleaning house and is more severe than any previous episode. Upon admission in the ER, HR was 120 beats per minute and blood pressure was 180/110. The patient was cyanotic around the lips and nail beds and had severe edema in feet and lower legs. The results of an EKG and cardiac enzyme blood tests were normal. Medication improved the symptoms but she was admitted for observation and a complete cardiac workup for tachycardia, hypertension. Summary of Hospital Course: Patient underwent a full battery of cardiac diagnostic tests. A prolapsed mitral valve was observed on an echocardiogram. A treadmill test had to be stopped early due to onset of severe difficulty in breathing and cyanosis of the lips. Arterial blood gases showed low oxygen, and supplemental oxygen per nasal canula was required to resolve cyanosis. Angiocardiography failed to demonstrate significant coronary artery thrombosis. Blood pressure, tachycardia, anxiety, and pitting edema were controlled with medications. Patient took Lopressor to control blood pressure, Norpace to slow heart rate, Valium for the anxiety, and Lasix to reduce edema. At discharge, HR was 88 beats per minute, blood pressure was 165/98, and there was no evidence of edema unless she was on her feet too long. Discharge Plans: There was no evidence of a myocardial infarction and with lack of significant coronary thrombosis, angioplasty is not indicated for this patient. Patient was placed on a low-salt and low-cholesterol diet. She re- ceived instructions on beginning a carefully graded exercise program. She is to continue Lasix, Norpace, Valium, and Lopressor. If symptoms are not controlled by these measures, a mitral valve replacement will be considered. Critical Thinking Questions 1. List the four medications this patient was given in the hospital and describe in your own words what condition each medication treats. a. b. c. d. 2. Two diagnostic tests conducted in the Emergency Room were normal. List them and describe each test in your own words. Because the results from these two tests were normal, a very serious heart condition could be ruled out. This is noted in the discharge plans. Identify the serious heart condition and describe it in your own words. 3. Explain in your own words why the treadmill test had to be stopped. 4. Which of the following is NOT one of the admitting diagnoses? a. high blood pressure b. dizziness c. difficulty breathing d. fast heartbeat 5. The physician has two treatment options for this patient: medication and surgery. If the medication fails to control her condition, then describe what surgery will be considered. 6. Compare and contrast valve stenosis and valve prolapse. Cardiovascular System 157 Chart Note Transcription Chart Note The chart note below contains 11 phrases that can be reworded with a medical term that you learned in this chapter. Each phrase is identified with an underline. Determine the medical term and write your answers in the space provided. Current Complaint: A 56-year-old male was admitted to the Cardiac Care Unit from the Emergency Room with left arm pain, severe pain around the heart ①, an abnormally slow heart beat ②, nausea, and vomiting. Past History: Patient reports no heart problems prior to this episode. He has taken medication for high blood pressure ③ for the past 5 years. His family history is significant for a father and brother who both died in their 50s from death of heart muscle ④. Signs and Symptoms: Patient reports severe pain around the heart that radiates into his left jaw and arm. A record of the heart’s electrical activity ⑤ and a blood test to determine the amount of heart damage ⑥ were abnormal. Diagnosis: An acute death of heart muscle resulting from a blood clot in a coronary vessel ⑦. Treatment: First, provide supportive care during the acute phase. Second, evaluate heart damage by passing a thin tube through a blood vessel into the heart to detect abnormalities ⑧ and evaluate heart fitness by having patient exercise on a treadmill ⑨. Finally, perform surgical intervention by either inflating a balloon catheter to dilate a narrow vessel ⑩ or by open heart surgery to create a shunt around a blocked vessel 1. _____________________________________________________________________________________________________ 2. _____________________________________________________________________________________________________ 3. _____________________________________________________________________________________________________ 4. _____________________________________________________________________________________________________ 5. _____________________________________________________________________________________________________ 6. _____________________________________________________________________________________________________ 7. _____________________________________________________________________________________________________ 8. _____________________________________________________________________________________________________ 9. _____________________________________________________________________________________________________ 10. _____________________________________________________________________________________________________ 11. _____________________________________________________________________________________________________ 158 Chapter 5 Practice Exercises A. Complete the following statements. 1. The study of the heart is called ____________________ . 2. The three layers of the heart are ____________________ , ____________________ , and ____________________ . 3. The impulse for the heartbeat (the pacemaker) originates in the ____________________ . 4. The artery that does not carry oxygenated blood is the ____________________ . 5. The four heart valves are ____________________ , ____________________ , ____________________ , and ____________________ . 6. The ____________________ are the receiving chambers of the heart and the ____________________ are the pumping chambers. B. State the terms described using the combining forms provided. The combining form cardi/o refers to the heart. Use it to write a term that means 1. pain in the heart _________________________________________________________________________________ 2. disease of the heart muscle ________________________________________________________________________ 3. enlargement of the heart _________________________________________________________________________ 4. abnormally fast heart rate _________________________________________________________________________ 5. abnormally slow heart rate ________________________________________________________________________ 6. inflammation of the heart _________________________________________________________________________ The combining form phleb/o refers to the vein. Use it to write a term that means 7. inflammation of a vein ___________________________________________________________________________ 8. opening a vein (to withdraw blood) ________________________________________________________________ 9. suture a vein ____________________________________________________________________________________ The combining form arteri/o refers to the artery. Use it to write a term that means 10. pertaining to an artery ___________________________________________________________________________ 11. hardening of an artery ____________________________________________________________________________ C. Add a prefix to -carditis to form the term for 1. inflammation of the inner lining of the heart____________________ 2. inflammation of the outer layer of the heart____________________ 3. inflammation of the muscle of the heart____________________ D. Define each combining form and provide an example of its use. Definition Example 1. ciardi/o _________________________________________________________________________________________ 2. valvul/o ________________________________________________________________________________________ 3. steth/o _________________________________________________________________________________________ 4. arteri/o _________________________________________________________________________________________ 5. phleb/o _________________________________________________________________________________________ 6. angi/o __________________________________________________________________________________________ 7. ventricul/o ______________________________________________________________________________________ Cardiovascular System 159 8. thromb/o _______________________________________________________________________________________ 9. atri/o ___________________________________________________________________________________________ 10. ather/o _________________________________________________________________________________________ E. Write medical terms for the following definitions. 1. pertaining to a vein ______________________________________________________________________________ 2. fast heartbeat ____________________________________________________________________________________ 3. specialist in treating the heart _____________________________________________________________________ 4. recording electrical activity of heart ________________________________________________________________ 5. high blood pressure ______________________________________________________________________________ 6. low blood pressure _______________________________________________________________________________ 7. inflammation of inner lining of heart _______________________________________________________________ 8. bluish coloring to skin ____________________________________________________________________________ 9. destruction of a clot ______________________________________________________________________________ 10. narrowing of the arteries _________________________________________________________________________ F. Write the suffix for each expression and provide an example of its use. Suffix Example 1. pressure ________________________________________________________________________________________ 2. abnormal narrowing _____________________________________________________________________________ 3. instrument to measure pressure ___________________________________________________________________ 4. small ___________________________________________________________________________________________ 5. hardening _______________________________________________________________________________________ G. Identify the following abbreviations. 1. BP _____________________________________________________________________________________________ 2. CHF ____________________________________________________________________________________________ 3. MI _____________________________________________________________________________________________ 4. CCU ____________________________________________________________________________________________ 5. PVC ____________________________________________________________________________________________ 6. CPR ____________________________________________________________________________________________ 7. CAD ___________________________________________________________________________________________ 8. CP _____________________________________________________________________________________________ 9. EKG ____________________________________________________________________________________________ 10. S1 _____________________________________________________________________________________________ H. Write the abbreviations for the following terms. 1. mitral valve prolapse _____________________________________________________________________________ 2. ventricular septal defect __________________________________________________________________________ 3. percutaneous transluminal coronary angioplasty _____________________________________________________ 4. ventricular fibrillation ____________________________________________________________________________ 5. deep vein thrombosis _____________________________________________________________________________ 6. lactate dehydrogenase ____________________________________________________________________________ 7. coarctation of the aorta ___________________________________________________________________________ 160 Chapter 5 8. tissue-type plasminogen activator __________________________________________________________________ 9. cardiovascular ___________________________________________________________________________________ 10. extracorporeal circulation _________________________________________________________________________ I. Match the terms in column A with the definitions in column B. A B 1. _____ arrhythmia a. swollen, distended veins 2. _____ thrombus b. inflammation of vein 3. _____ bradycardia c. serious congenital anomaly 4. _____ bruit d. slow heart rate 5. _____ phlebitis e. insert thin tubing 6. _____ commissurotomy f. irregular heartbeat 7. _____ varicose vein g. murmur 8. _____ tetralogy of Fallot h. clot in blood vessel 9. _____ catheterization 10. _____ sphygmomanometer i. to change the size of an opening j. blood pressure cuff J. Use the following terms in the sentences that follow. angioma angina pectoris echocardiogram MI angiography varicose veins hypertension CHF defibrillation Holter monitor pacemaker CCU murmur 1. Tiffany was born with a congenital condition that results in an abnormal heart sound. This is called a(n) ____________________ . 2. Joseph suffered an arrhythmia while hospitalized that resulted in a cardiac arrest. The emergency physician and team used an instrument to give electric shocks to the heart in an attempt to create a normal heart rhythm. This procedure is called ____________________ . 3. Marguerite has been placed on a low-sodium diet and medication to bring her blood pressure down to a normal range. She suffers from ____________________ . 4. Tony has had an artificial device called a(n) ____________________ inserted to control the beating of his heart by producing rhythmic electrical impulses. 5. Derrick’s physician determined that he had ____________________ after examining his legs and finding swollen, tortuous veins. 6. Laura has persistent chest pains that require medication. The term for the pain is ____________________ . 7. La Tonya is going to have surgery to correct her heart condition. She will be admitted to what hospital unit after her surgery? ____________________ 8. Stephen is going to have a coronary artery bypass graft to correct the blockage in his coronary arteries. He recently suffered a heart attack as a result of this occlusion. His attack is called a(n) ____________________ . 9. Stephen’s physician scheduled an X-ray to determine the extent of his blood vessel damage. This test is called a(n) ____________________ . 10. A patient who is scheduled to have a diagnostic procedure that uses ultrasound to produce an image of the heart valves is going to have a(n) ____________________ . 11. Rolando has been diagnosed with a benign tumor of the blood vessels. This is called a(n) ____________________ . 12. Eric must wear a device for 24 hours that will keep track of his heart activity as he performs his normal daily routine. This device is called a(n) ____________________ . 13. Lydia is 82 years old and is suffering from a heart condition that causes weakness, edema, and breathlessness. Her heart failure is the cause of her lung congestion. This condition is called ____________________ . Professional Journal In this exercise you will now have an opportunity to put the words you have learned into practice. Imagine yourself in the role of a cardiology technologist, electrocardiogram technician, or a cardiac sonographer. If you refer back to the Professional Profile at the beginning of this chapter, you will see that these health care professionals are responsible for performing diagnostic tests and treatments such as invasive heart procedures, EKGs, and echocardiograms. Use the 10 words listed below, or any other new terms from this chapter, to write sentences to describe the patients you and the whole cardiology technology team saw today. An example of a sentence is: Mr. Brown’s heart rate was so slow he will require a pacemaker implantation. 1. aneurysm __________________________________________________________________________________________ 2. angiography _______________________________________________________________________________________ 3. cardiac catheterization _______________________________________________________________________________ 4. electrocardiogram ___________________________________________________________________________________ 5. arrhythmia ________________________________________________________________________________________ 6. mitral valve prolapse ________________________________________________________________________________ 7. cardiomegaly _______________________________________________________________________________________ 8. stent ______________________________________________________________________________________________ 9. fibrillation _________________________________________________________________________________________ 10. coronary artery disease ______________________________________________________________________________ 162 Chapter 5 MedMedia CD-ROM www.prenhall.com/fremgen Use the CD-ROM enclosed with your textbook to gain additional reinforcement through interactive word building exercises, spelling games, labeling activities, and additional quizzes. Use the above address to access the free, interactive Companion Website created for this textbook. Get hints, instant feedback, and textbook references to chapter-related multiple-choice questions, and labeling and matching exercises. In addition, you will find an audio glossary, case studies, Internet exploration exercises, flashcards, and a comprehensive exam. For more information regarding cardiovascular diseases visit the following websites: American College of Cardiology at www.acc.org National Heart, Lung, and Blood Institute at www.nhlbi.nih.gov American Heart Association at www.americanheart.org Centers for Disease Control and Prevention—Cardiovascular Health at www.cdc.gov/cvh/aboutcardio/htm Karolinska Institute Library, Stockholm, Sweden—Cardiovascular Disease Resources List at www.mic.ki.se/diseases/index/html Cardiovascular System 163